Peresepan olahraga

Urgensi
- Olahraga lebih efektif dibandingkan obat pada penyakit stroke dan sama efektifnya
sebagai preventif sekunder dari penyakit Coronary HD dan DM
- 150 MVPA/minggumenurunkan risiko penyakit kronis 25-50%
- 15 menit MVPA/hari (75 menit/weej)menurunkan 15% risiko kematian
Yang perlu dilakukan
- PAR Q+
- Eval kondisi klinis melalui anamnesis dan px fisik
o MVPA dikontraindikasikan pd pasien unstable angina, aritmia, decom HF
o Murmur, BP >200/110mmhg
Fungsi olahraga
- Reduces the risk of dying prematurely
- Reduces the risk of dying from heart disease
- Reduces the risk of stroke
- Reduces the risk of developing diabetes
- Reduces the risk of developing high blood pressure
- Helps reduce blood pressure in people who already have high blood pressure
- Reduces the risk of developing colon cancer
- Reduces feelings of depression and anxiety
- Helps control weight
- Helps build and maintain healthy bones, muscles, and joints
- Helps older adults become stronger and better able to move about without falling
- Promotes psychological wellbeing
OBESITY
Exercise duration — For those who are able, walking 150 to 250 minutes per week
(≥30 min/day, five to seven days per week) is beneficial in preventing weight gain and in
improving cardiovascular health [10,23]. This will increase energy expenditure by 1000 to
1200 calories per week, or slightly more than 150 calories per day. The amount of energy
expended depends upon the duration and intensity of the exercise and the subject's initial
weight (table 2). As an example, a 120-pound person walking three miles per hour expends
slightly less than 2 calories per minute more than standing still. At 160 pounds, the difference
is 2.4 calories per minute, and at 200 pounds, it is 3 calories per minute. Thus, a 30-minute
walk at three miles per hour for a person weighing 200 pounds would dissipate an extra 90
calories as compared with 60 calories for a person weighing 120 pounds.
In the weight loss maintenance period, most people require >60 minutes per day of moderate-
intensity activity to successfully maintain the loss [23].
Exercise type and intensity — A multicomponent program that includes aerobic and
resistance training is preferred [51]. As an example, a program that includes balance training
(15 minutes) and flexibility (15 minutes) (particularly for older adults), aerobic exercise (30
minutes), and high-intensity resistance training (30 minutes) may be effective. However, any
type of physical activity is better than none, and combining activities the patient is willing and
able to do may be the most important factor to consider when designing a program for your
patients.

HYPERTENSION
NUTRITION
In 2013, the World Health Organization (WHO) recommended that adults consume
<2000 mg/day of sodium.
●The 2015 United States Dietary Guidelines, prepared by the United States Departments
of Agriculture and of Health and Human Services, recommend that adults consume
≤2300 mg/day of sodium [5].
●The American Heart Association set 1500 mg/day of sodium as the recommended upper
limit of intake for all Americans [6].
●The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a
sodium intake of <2.0 g (90 mmol)/day for patients with chronic kidney disease not on
dialysis [63].
Potassium — 40-80 mEq/day
Magnesium — Higher magnesium intake has been associated with lower BP [17,18].
Fish oil — High-dose, but not low-dose, fish oil supplements may reduce systemic BP by up
to 6/4 mmHg [19-22]. A metaregression analysis of 36 trials of fish oil, of which 22 had a
double-blind design, found that the intake of a median dose of 3.7 g/day of fish oil provided
statistically significant reductions of both systolic and diastolic pressures (2.1/1.6 mmHg) [23].
The long-term safety of fish oil in doses high enough to lower the BP is at present unknown.
Potential toxicities include a bleeding tendency due to prolongation of the bleeding time, a
possible decline in renal function due to decreased production of the renal vasodilator
prostaglandin E2, eructations, the sensation of a fishy taste, and a possible deleterious effect
on lipid metabolism [19,22]. These considerations plus the generally modest antihypertensive
effect argue against the routine use of fish oil supplements.
Fish intake — Fish intake in combination with weight loss may have additive effects on BP
reduction [24,25]. In one 16-week randomized trial, fish intake plus weight loss was associated
with a reduction in BP from 133/77 mmHg to 119/68 mmHg, twice that observed with either
intervention alone [24].
Calcium — Although there appears to be an inverse relation between dietary calcium intake
and BP [26], both dietary calcium and calcium supplements have a relatively small effect on
BP. This was illustrated in a meta-analysis including all 40 randomized, controlled trials
available up to June 2003 relating to the relationship between hypertension and either dietary
(dairy) or nondietary supplements of calcium, which found a reduction in BP of 1.86/0.99
mmHg, with a trend toward larger effects in those with low baseline calcium intake [27].
The effect of supplemental calcium on BP is too small to recommend the use of calcium
supplements for the therapy or prevention of hypertension. Moreover, in a community-based,
prospective, longitudinal cohort study, high intake of calcium was associated with higher death
rates from all causes and cardiovascular disease [28].
High-fiber diet — A higher intake of dietary fiber is associated with decreased systemic
pressures [29]. Multiple meta-analyses have shown benefits with dietary fiber intake on BP
[29,30]. As an example, a 2005 meta-analysis of 24 randomized, placebo-controlled trials
published between 1966 and 2003 on the effects of fiber supplementation found an average fall
of 1.2/1.3 mmHg with fiber intake (average dose of 11.5 g/day) [29]. More significant
reductions were observed in older (greater than 40 years) and hypertensive individuals.
In a prospective, double-blinded, placebo-controlled, randomized trial of 110 subjects,
individuals given 30 g of milled flaxseed had a systolic/diastolic lower BP of 10/7 mmHg [31].
Protein intake — Replacing carbohydrate intake with soy (vegetable) or dairy protein may
reduce BP [32-37]. As an example, one study randomly assigned 302 Chinese subjects with
untreated hypertension (systolic BP between 130 to 159 mmHg) to soybean protein or
carbohydrate complex control [34]. After 12 weeks, systolic and diastolic BPs were 4.3 and
2.8 mmHg lower among those taking the protein supplement, compared with the control group.
There was a greater effect among those with hypertension at baseline (BP >140/90 mmHg).
Folate — An inverse association of folate intake with BP or hypertension has been shown in
three large, prospective, cohort studies [38,39], as well as in several randomized trials [40-42].
In a meta-analysis of 12 randomized trials, supplemental folic acid (5 mg/day or more)
significantly reduced systolic, but not diastolic, BP by 2.0 mmHg as compared with placebo
[42].
Flavonoids — The beneficial effect of fruits and vegetables on BP may be due in part to an
increased intake of polyphenols (eg, flavonoids). Significant sources of these compounds in
Western countries include tea and cocoa products. The effect of cocoa on BP was evaluated in
a 2012 Cochrane meta-analysis of 20 studies consisting of 856 subjects [43]. At a median
duration of intake of 4.4 weeks, flavanol-rich cocoa products significantly reduced both
systolic and diastolic pressure compared with placebo (mean reduction, 2.8/2.2 mmHg)
EXERCISE
Dynamic aerobic exercise — The most extensively studied form of exercise is dynamic
aerobic exercise, which is the regular and purposeful movement of large muscle groups in
moderate and/or vigorous activity that places stress on the cardiovascular system. Examples
include brisk walking, jogging, dancing, bicycling, swimming, and using certain exercise
equipment, such as elliptical machines.
The amount of aerobic exercise performed is measured as the intensity compared with rest
(expressed in metabolic equivalents [METs]), duration (minutes per session), and frequency
(number of sessions per week).
More intense exercises require more METs; walking at 3 miles/hour uses 3.5 METs, jogging
at a 14 min/mile pace uses 6 METs, and jogging at a 10 min/mile pace uses 10 METs. The total
amount of dynamic aerobic activity can then be expressed as "exercise volume," which is the
product of average METs multiplied by the total number of minutes per week, with the goal of
reaching 500 to 1000 MET min/week. As an example, walking 3 miles/hour for 30 minutes,
five times per week (ie, 150 minutes per week) requires 525 MET min/week.
Dynamic resistance exercise — Evidence on the effects of dynamic resistance exercise is
limited and inconsistent, even though some meta-analyses have concluded that dynamic
resistance exercise modestly lowers blood pressure [12]. This type of exercise is characterized
by effort that is performed against an opposing force accompanied by purposeful movement of
joints and large muscle groups. Common types of dynamic resistance exercise include weight
lifting and circuit training, often with the use of exercise equipment. These types of exercise
are typically performed with a goal of progressively increasing muscle strength. An ancillary
benefit might be blood pressure reduction.
Isometric resistance exercise — Even less evidence is available to support the blood pressure
effects of isometric resistance exercise. Isometric resistance is characterized by sustained
contraction of muscles with no change in the length of the involved muscle groups and no
change in joint angle. Isometric resistance exercise may involve equipment, such as handgrips;
other forms do not use equipment and involve maintaining a constant position such as sitting
against a wall without a chair or maintaining a push-up position.
Dose of exercise — There is no one exercise prescription that is appropriate for all adults. The
prescription should be individualized to the patient's capabilities and to prevent injuries and
maximize incentives for maintaining a consistent regimen.
Changing patients' behavior is often challenging, and supplying information and general
recommendations alone is often insufficient. Hence, clinicians should provide the exercise
prescription coupled with practical solutions, such as exercising with family and friends,
joining community groups, and tracking minutes or counts of physical activity.
Reasonable exercise prescriptions include, but are not limited to, the following :
●At least 150 minutes of moderate-intensity physical activity per week; this corresponds
to approximately 30 minutes per day, five or more days per week.
●At least 75 minutes of vigorous-intensity physical activity per week; this corresponds
to approximately 30 minutes per day, three or more days per week.
In some patients, it is also reasonable to advocate for a modest increase in physical activity
even if the specific goals above are not met.
Moderate and vigorous activity are technically defined by percentile of peak VO2 (ie, the peak
rate of oxygen consumption) or by maximum heart rate. However, describing exercise to
patients in these terms is not practical. Rather, clinicians should mention that, in general,
individuals can talk during moderately intense activity. However, during vigorous-intensity
activity, individuals can say no more than a few words without pausing for a breath.
DM
How does exercise help?
Increasing physical activity can reduce the incidence of T2DM by almost 60% in people at risk
(5). Studies show that exercise can help prevent or delay T2DM, improve management of blood
glucose, decrease the proportion of body fat, decrease the risk of heart disease, and increase
heart and lung fitness in people with T2DM (7). Non-optimal blood glucose levels leads to
earlier onset of associated diseases and complications such as heart, kidney and eye diseases,
and an increased risk of death. Improved blood glucose management often means people can
reduce their T2DM medications. As people with diabetes age, the benefit of maintaining
muscle mass through exercise is also likely to improve physical function and independence (8).
What exercise is best for people T2DM?
The table below shows the type, intensity, duration and frequency of exercise recommended
for people with T2DM. The total amount of exercise should include a combination of aerobic
and resistance training. Aerobic exercise (e.g. walking or running) increases heart and lung
fitness, while resistance training (e.g. lifting weights) can maintain and increase muscle and
bone strength. Importantly, combining both aerobic and resistance training has recently shown
to be more beneficial on blood glucose levels in people with T2DM (2).